Q 1) Where do transplant kidneys come from?
A) There are 2 sources for kidney:
Living “related” donors (which include parents, siblings, children or spouse).
- Non-living cadaver donors.
- Many people do not have suitable donors. They are placed on the transplant waiting list. The length of time you wait for a kidney is unpredictable because it depends on the availability of cadaver donors.
Q 2) How is the donor screened?
A) Donor is screened for:
- ABO blood group. A compatible blood group is a must for donor to be acceptable.
- Tissue typing (HLA typing). The better the match , the less is the chance of rejection.
In addition, a detailed evaluation of the donor has to be done to assess his/her suitability to donate kidney.
Q 3) How is the recipient evaluated?
A) The pre-transplant evaluation has to be done by the transplant team to assess patient’s suitability for transplant surgery. The evaluation includes many of the routine blood tests which may be done several times. In addition, the following tests may have to be done,
- Chest X-Ray
- ECG (Electrocardiogram)
- Abdominal Ultrasound
- Special blood test to screen for hepatitis B & C, AIDS (HIV) virus
- Social & psychiatric evaluation
In addition, further testing may be required because of other health conditions. The transplant doctors decide which additional tests are required.
Q 4) What are the additional health problems that may increase the risks involved with transplant?
- Advanced age: Transplant candidates who are over 60 yrs of age generally have more difficulty compared with younger patients.
- Heart disease: Many kidney patients have heart disease. Candidates with a history of angina or heart attack need to discuss this risk with the transplant doctor.
- Chronic lung disease: (asthma, chronic bronchitis, or emphysema). These candidates have an increased risk of pneumonia after transplantation.
- Smoking: the short term risks for smokers are similar to people with chronic lung disease. The long term risks for smokers who receive a transplant may include increased risk of lung and throat cancer. Patients are strongly urged not to smoke.
There are other problems such as being overweight or having exposure to hepatitis or tuberculosis that have risks. These issues have to be discussed with the doctor before transplantation.
Q 5) What precautions should I take after transplant?
A) You must regularly take medications prescribed to prevent rejection of your new kidney. The drugs prescribed for you may be different from those prescribed for other people. Your body will reject the kidney if you stop taking the prescribed drugs. These medications can be more costly than your current medications. Since these drugs alter the immune system you may at higher risk of contracting infections.
Q 6) What is the solution for the problem of Benign Prostate Hyperplasia?
A) Benign Prostate Hyperplasia (BPH) can be effectively managed by a variety of therapeutic agents available in the market. However, it has been observed that many people hesitate to present their case to the doctor. A social stigma is associated with this disorder. Many people ignore the symptoms just by thinking BPH is an age-related problem, which has got no cure. People suffering from BPH usually prefer to remain aloof and are isolated from family and society. This adds on to the psychological pressure or depression in these patients.
Q 7) What are the treatment options available for Benign Prostate Hyperplasia?
A) After presentation of Benign Prostate Hyperplasia (BPH) case, the doctor will examine the patient and may ask for further investigations like Ultrasonography, Uroflowmetry analysis etc. if required. Depending on the severity of the disease, the treatment options for the patient are medical therapy or surgery.
Q 8) Is surgery mandatory for all the patients?
A) No, depending on the severity of the symptoms and the growth of the prostate, the doctor will decide the treatment option. The most widely accepted mode of surgical treatment is a Trans – urethral resection of Prostate (TURP). It is carried out by a camera assisted device which is inserted through the urethra. Being a short procedure, it is generally done under local or a short general anaesthesia. It is quite safe, and at the hands of an experienced surgeon, it has very low post-operative morbidity.
Q 9) What are the causes of Kidney Disease?
A) The major cause of kidney failure is Hypertension, Diabetes, ureteric obstruction due to stone, drugs mainly the pain killers & radiation. Many other conditions can harm the kidneys like glomerulonephritis (Inflammation of Kidneys) & inherited diseases like polysystic kidney disease, which causes many cysts to form in the kidneys
Q 10) What should I do if I’m at increased risk of Chronic Kidney Disease ?
- Follow prescribed treatments to control Diabetes / Hypertension (Blood Pressure) regularly.
- Lose excess weight by following a healthy diet & regular exercise programme.
- Quit smoking & drinking alcohol.
- Avoid self medication e.g. Pain Killers.
- Modify your diet as per your Doctors advice.
Q 11) If I have Chronic Kidney Disease, How you I manage it?
- Control high blood pressure.
- Control Blood sugar
- Follow a special diet
- Treat anemia with Erythropoetin (Hormone) & iron supplements.
- Prevent bone disease
- Follow an exercise program.
- Take corrective measures to prevent heart problems.
- Quit smoking & consumption of alcohol
- Consult your Doctor regularly
Q 12 ) What is hemodialysis, how is it done ?
A) It is a treatment that cleanses the blood, the wastes & excess
fluid that has built up. During hemodialysis, the blood travels through soft tubes to a dialysis machine.As the blood is cleansed, it is returned to the patient’s blood stream. Only a small amount of blood is out of your body at any time.
In order to be connected to the machine, patient needs to have an access or entrance to the bloodstream which can be done in following 3 ways,
- Fistula: is a connection done with a minor surgery, between an artery & a nearby vein in the arm.
- Graft: is made by using a piece of soft tubing to connect an artery & vein in the arm or sometimes in the leg.
- Catheter: is made by inserting a soft tube into a vein, usually in the neck or upper chest. Catheter is a temporary access. Fistula should be considered the 1st choice for an access as they tend to last longer & have fewer problems such as infection & clotting. Fistulas take several weeks to enlarge & become ready for dialysis, that’s why fistulas have to be made in advance. If the blood vessels are not strong enough for a fistula the vascular surgeon may decide to make a graft instead.
Q 13) What is peritoneal dialysis?
A) In peritoneal dialysis, blood travels through peritoneum membrane (in abdomen) & this membrane acts as a natural filter. A cleansing solution called dialysate, is passed into the abdomen through a catheter which is surgically placed. Wastes & excess fluid pass from the blood into the cleansing solution. After 6-8 Hrs the solution is drained out & again refilled with fresh dialysate to begin the next cleansing procedure. Each exchange take min 20-30 minutes. Peritoneal dialysis can be done at home, work, school or even during traveling.
Q 14) What does Diabetes do to the kidneys?
A) After years of diabetes, the filtering units of your kidney become scarred and do not filter blood efficiently. Kidney disease is the deterioration in the ability of your kidneys to perform their regular functions, one of which is filtering waste products from the blood as a result, your body will retain more water & salt than it should, which can result in weight gain & ankle swelling. Protein in urine may be seen.
Diabetes also damages the nerves in your body. This can cause difficulty in emptying your bladder. The pressure that results from your full bladder can back up & injure the kidneys. If urine stays in your bladder for a long time, you may develop a urinary tract infection as bacteria grows rapidly in urine with a high sugar level.
Q 15) Does it mean that experiencing no health problems indicates diabetes is under control?
A) A person with uncontrolled diabetes may still seem to be in good health. Normal level of blood sugar is a proper indication of control of diabetes.
Q 16) If a person starts taking insulin injections, does he have to take it for his entire life?
A) A person is put on insulin when his pancreas cannot produce required amount of insulin. When insulin Injections are taken, the pancreas is allowed to rest & it can possibly regain its ability to produce insulin. If this happens the insulin injection can be stopped & the person can be put back on the tablets.
Q 17) What is High Blood pressure (hypertension)?
A) It is the force of blood against your artery walls, high enough to cause damage. The higher the blood pressure, the harder the heart has to pump to feed the tissues. Constant untreated elevated pressure may give rise to stroke, heart attack, blindness and kidney disease. One high reading may not mean you have high blood pressure. Your diagnosis of high blood pressure must be confirmed on follow-up with your doctor. For most adults, High BP is defined as systolic pressure of 140 or higher or Diastolic pressure of 90 or higher. The desired B P for diabetics or chronic kidney patients is below 130/80.
Q 18) What are the risk factors which may contribute to High Blood Pressure?
Heredity: A family history of hypertension & Heart Disease raises the risk for hypertension.
- Age : Arteries lose their elasticity as we age with a consequent increase in B P. Weight gain during adult life is also responsible for much of the rise in the B P seen with ageing.
- Obesity: “Longer the waistline, shorter the lifeline”. More so excess abdominal obesity. Waist circumference is more than 34” in women & more than 39” in men is associated with 4-6 times increase risk of Hypertension.
- Alcohol: It is a toxic to every cell of the body.
- High Salt & fat intake
- Too little exercise, sedentary lifestyle
Q 19) How are High B P & Kidney Disease Related?
A) High B P is the most common cause of kidney disease next to diabetes. In addition, High B P increases the rate of loss of Kidney function in people with kidney disease. Nephrons (working units of Kidneys) are affected after years of stress from High BP. Your Doctor can detect the percent of Kidney Damage by checking protein in your urine, glomerular filtration rate (GFR) from a simple blood test. People with High B P are at increased risk for developing Chronic Kidney Disease, it is imp to be tested for kidney disease. The simplest method to detect Kidney Disease in High B P is to do urine test & blood test for creatinine.
Q 20) What do I do to help prevent kidney stones?
A) To help prevent kidney stones, drink plenty of water min 10-12 glasses.
- If you observe symptoms of kidney stone, such as pain, nausea & vomiting, blood in urine, more frequent urination, fever & chills, please meet your doctor immediately.
- Your doctor will do simple & economical blood & urine tests & ultrasonography(USG) to confirm the stone & decides the treatment accordingly.
- If you want to avoid repetition of stone forming you may have to change your diet & continue on medication (please discuss with your doctor).
- Most stones pass on their own. Treatment may be needed if a stone is too large to pass, blocks the flow of urine, or causes infections, kidney damage or constant bleeding.
Q 21) What are the treatments available for kidney stones?
A) If kidney stone is confirmed, drink plenty of water min. 3-4 lit. because most of the stones pass on their own. Check the diet; take advice from your doctor.
- Extracorporeal Shock Wave Lithotripsy (ESWL): In this treatment, shock waves from a source outside the body are focused on stone & when it hits stone, it breaks down in small fragments that can pass out of the body with urine. Patients may feel some pain as the stone fragments pass through the urinary tract.
- Percutaneous stone removal: this treatment may be used when stone is very large or located in an area where ESWL is not effective. Surgeon makes a very small incision in the back & creates a tunnel into the kidney. The stone is then removed through a tube called nephroscope. Patient usually is being hospitalized for 1 or 2 days.
- Urethroscopic Stone removal: Surgeon passes a small fiber optic instrument through the urethra & bladder into the ureters. Once the stone is located, it is removed with a cage-like device or shattered with laser beams or shock waves.
Q 22) How do I know if I’m receiving enough hemodialysis?
A) The hemodialysis treatments you’re receiving replace only a small part (less than 15%) of the normal function of the kidneys. If you don’t even get this much treatment, your blood, will retain too much of the body’s waste products that cause uremia and you will always feel sick. However, some people who are underdialysed experience no symptoms in the beginning. In the long run they will definetly become sicker.If you’re being underdialyzed you can expect to experience many symptoms such as:
- Weakness and tiredness all the time
- Loss of real weight
- Poor appetite
- A taste of ammonia in your mouth
- Bone pains
Q 23) What can I do to keep well on dialysis?
- Follow your diet and fluid restrictions. Your dietician can help you and give you suggestions.
- Take all of your medicines as they’re prescribed.
- Check your fistula each day and before each treatment. Daily care and monitoring of your fistula is essential to keeping your “lifeline” working as long as possible. If you suspect any problems, call your doctor.
- Exercise on a regular basis. Remember to talk to your doctor before starting an exercise program.
- Always attend each scheduled treatment for the full time that’s prescribed. Missing a few minutes each time can add up and cause your body harm over a period of time.
- Follow the advice of your dialysis staff on taking care of yourself. They are to help you take care of yourself and do well on your treatment.
- Check the ratio of post-dialysis BUN to pre-dialysis BUN every month. It should be less than 0.35. if it is not so, you are not getting enough dialysis.
- Keep a record of your numbers and blood chemistries. Talk to your dialysis care team if they are lower or higher than the goal.
Q 24) What dialysis cannot do?
A) Dialysis can’t replace hormones. Your kidneys are part of the endocrine system. The endocrine system controls certain body functions by making and releasing hormones into the bloodstream. When your kidneys are damaged, they produce very little hormones or none at all. Unfortunately dialysis cannot replace or manufacture these chemicals (i.e. calcitriol, erythropoietin and renin). These are to be replaced in the body with medication.
Q 25) What is a kidney biopsy?
A) A kidney biopsy is done by inserting a long needle through the back (flank) to remove a sample of kidney tissue. The tissue sample can then be sent to a laboratory and examined under a microscope to help a doctor determine the condition of the kidney and look for signs of infection or other diseases.
A kidney biopsy provides kidney tissue which may be microscopically examined for the following purposes:
- • To diagnose the cause of kidney disease (Lupus nephritis, glomerulonephritis, etc.)
- • To detect malignancy (primary and metastatic) in the kidney
- • To evaluate rejection and degree of rejection in a kidney transplant patient (this allows the physician to adjust immunosuppressive doses)
By Dr. Umesh Khanna
Chairman, Mumbai Kidney Foundation
Trustee, Sapiens Health Foundation
Secondary, Amar Gandhi Foundation